Perioperative Medicine Web-Based Curriculum & Reference

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PERIOPERATIVE MEDICINE

Web-Based Curriculum & Reference

Editors

Kurt J. Pfeifer, MD, FACP

Steven L. Cohn, MD, FACP

Medical College of Wisconsin

State University of New York - Downstate

Pregnancy

Michael P. Carson, MD & David A. Halle, MD

	RISK MANAGEMENT
	Intraoperative Management

	PATIENT POSITIONING
	Place a wedge under the patient’s right hip to avoid aortocaval compression. Aortocaval compression can decrease venous return, cardiac output and uterine perfusion as early as 20 weeks gestation. Compression can also occur when the pregant patient assumes the “fetal” position in preparation for epidural or spinal anesthesia.
	FETAL MONITORING
	Fetal heart rate (FHR) monitoring was designed for labor and is less reliable <24 weeks gestation. FHR changes unlikely to occur without obvious maternal compromise. Any concerns regarding intraoperative FHR should be addressed by the obstetrician.


PRIORITY: Maintain Maternal Well-Being
A healthy fetus needs a healthy mother. Do not withhold medications or treatments because of “potential” risks to the fetus when the benefit is clear cut.